tbuckley/cabot-search huggingface dataset:
Abstract 14686: Prevalence and Predictors of Normotensive Shock in Intermediate-Risk Pulmonary Embolism
Authors: Sripal Bangalore
Journal: Circulation (2022)

Introduction: In patients presenting with pulmonary embolism (PE) and shock/hypotension (high-risk PE), immediate thrombolytic therapy or mechanical thrombectomy is recommended. However, the prevalence and predictors of normotensive shock in patients with intermediate-risk PE are not well defined. Methods: PE patients undergoing mechanical thrombectomy with the FlowTriever System (Inari Medical) were enrolled in the FLASH Registry. Patients were included in this analysis if they were intermediate-risk per ESC guidelines (i.e., normotensive) and had cardiac index (CI) measured pre- and post-thrombectomy. Invasive hemodynamics were measured pre- and post-thrombectomy and compared using paired data. Patients were grouped into those with normotensive shock (CI ≤ 2.2 l/min/m 2 ) or without shock (CI &gt; 2.2 l/min/m 2 ). Multiple logistic regression was used to identify baseline predictors of normotensive shock. Safety outcomes through 30 days were recorded. Results: Out of 384 intermediate-risk PE patients, more than one-third (131, 34.1%) were in normotensive shock at baseline. The shock group had significantly lower BMI, higher RV/LV ratio, and higher rates of moderately/severely reduced RV function and concomitant DVT (Table). Significant predictors of shock included tachycardia, distal concomitant DVT, moderately/severely reduced RV function, and saddle PE. The normotensive shock group showed significant on-table improvement in CI and mean PA pressure post-thrombectomy (Figure). Safety profiles were not significantly different between groups, with similarly low rates of major adverse events and mortality through 30 days (Table). Conclusion Although identified as intermediate-risk, over one-third of patients had normotensive shock, suggesting they may be at risk of hemodynamic deterioration despite appearing stable. Treatment with mechanical thrombectomy improved patient hemodynamics on the table, with low rates of mortality in both groups.
Abstract 134: The Impact Of Alcohol Use On The Quality Of Cardiopulmonary Resuscitation: A Prespecified Analysis Of A Randomised Trial
Authors: Joris Nas, Jos Thannhauser, Priya Vart, Robert-jan M Van Geuns, Hella Muijsers, Jan-Quinten Mol, Goaris Aarts, Lara Konijnenberg, Frank Gommans, Sandra Ahoud-Schoenmakers, Jacqueline Vos, Niels Royen, Judith Bonnes, Marc Brouwer
Journal: Circulation (2022)

Objectives: Despite the undisputed impact of bystander cardiopulmonary resuscitation (CPR) in cardiac arrest, it is debated whether one should act as a rescuer after alcohol consumption, due to the perceived adverse effects. We provide the first objective data on the impact of alcohol use on CPR-quality and performance. Methods: Adult attendees of the Lowlands music festival (August 2019, the Netherlands) were randomized to virtual reality or face-to-face CPR-training. Randomisation was stratified according to alcohol level, measured using certified breathalyser tests. Alcohol levels are reported using the European unit of measure (‰), which is a factor of 10 higher than the US unit of measurement (%). Participants with an alcohol level ≥0.5‰ were only randomized if they successfully completed a tandem gait test. We studied three groups: alcohol level of 0‰ (Group 1), between 0 and 0.5‰ (Group 2) and ≥0.5‰ (Group 3). Results: We studied 352 participants, 56% female and median age 26 (22-31) years, with n=214 in Group 1, n=85 in Group 2 and n=53 in Group 3. There were no significant differences in compression depth and rate between the three study groups (depth: 57 [49-59] vs. 57 [51-60] vs. 55mm [47-59], p=0.16; rate: 115 [104-121] vs. 114 [106-122] vs. 111min -1 [95-120], p=0.19), see also Figure 1. There was no significant difference in the proportions complying with guideline-endorsed depth or rate or in the overall CPR-scenario performance score. There were no significant correlations between alcohol level and compression depth (Spearman’s rho -0.113, p=0.19) or rate (Spearman’s rho -0.073, p=0.39). Conclusion: In this study on recently trained festival attendees, we found no association between alcohol level and CPR-quality or performance. These findings indicate that alcohol intake may not be a barrier for performing potentially lifesaving CPR.
Abstract 14638: Survival Outcomes in Hospitalized COVID19 Patients With New Onset Cardiomyopathy
Authors: Sachin Kumar, Sarah Rikabi, Bindesh Ghimire, Raunak Nair, Grant W Reed, Umesh N Khot, Gautam Shah
Journal: Circulation (2022)

Introduction: Cardiac injury is known to occur in patients with COVID19 infection and is associated with a poor prognosis. However, there is limited data assessing the survival outcomes in hospitalized COVID19 patients with new-onset cardiomyopathy (NOC). We studied the impact of NOC on short and long term mortality in hospitalized COVID19 patients. Methods: We reviewed all cases of hospitalized COVID19 patients from the Cleveland Clinic COVID19 registry from 18 th March, 2020 to 18 th May, 2021 who received an in-hospital echocardiogram and had any prior echocardiogram to compare. The mean interval between the in-hospital and prior echocardiogram was 2.8 years. NOC was defined as a reduction in left ventricular ejection fraction (LVEF) of &gt; 10% with a new LVEF of &lt; 53%. The 30-day and 1-year mortality of patients with NOC were analyzed. Results: Of the 1537 hospitalized COVID19 patients receiving echocardiogram, 907 with a prior echocardiogram were included, of which 77 (8.5%) had NOC. Out of the 907 patients, 229 (25.2%) died within 30-days and 519 (57.2%) died within one year. It was found that patients with NOC had higher 30-day mortality than those without NOC (24.2% vs 36.4%, p=0.0078). However, the 1-year mortality was similar in the two groups (41.4% vs 45.3%, p=0.21). Conclusions: We found that NOC in hospitalized COVID19 patients was associated with higher 30-day mortality, however, it did not adversely impact the 1-year survival. Our findings suggest that although NOC is associated with worse short-term outcomes, long-term survival was primarily driven by the underlying disease process rather than the NOC.
Abstract 12740: Racial and Ethnic Disparities in Mortality in Patients Presenting With STEMI With COVID-19: NACMI Registry
Authors: Odayme Quesada, Mehmet Yildiz, Evan Walser-Kuntz, Larissa I Stanberry, Ross Garberich, Rodrigo Bagur, nima ghasemzadeh, Nayak Keshav, Akshay Bagai, jose wiley, Avneet SINGH, Joseph Aragon, Shoaib Amlani, Pedro Cox, Xuming Dai, Tareq Alyousef, Ameer Kabour, Rajan D Patel, Santiago A Garcia, M C Alraies, Payam Dehghani, Timothy D Henry
Journal: Circulation (2022)

Introduction: COVID-19 infection disproportionally impacts non-Whites with higher morbidity and mortality. However, differences by race and ethnicity in COVID-19 patients with concomitant STEMI have not been previously described. Methods: The North American COVID-19 STEMI (NACMI) registry is a prospective, observational registry enrolling COVID-19 patients with concomitant STEMI from 64 centers in Canada and the United States from March 2020 to December 2021. We compared clinical characteristics, treatment strategies, and in-hospital mortality risks by race/ethnicity. Results: Among 679 STEMI patients with concomitant COVID-19, 54.5% were White, 14.3% Black, 19.4% Hispanic/Latinx, and 11.8% Asian/Indigenous/Other. Blacks had the highest prevalence of current smokers, and Whites had the lowest prevalence of diabetes. The rate of high-risk features including cardiac arrest, cardiogenic shock, and inotropic support was comparable between the groups. Presence of infiltrates and cardiomegaly was higher in Blacks and Hispanic/Latinx; whereas, COVID-19 severity was similar in the groups. Blacks and Hispanic/Latinx and Blacks were more likely to not have coronary angiography performed. Among patients that underwent angiography, Whites and Hispanic/Latinx were more likely to be treated with primary PCI. In-hospital mortality was highest in Hispanic/Latinx (38%) and the Asian/Indigenous/Other group (Table). Conclusions: Despite no difference in high-risk features in patients with COVID-19 and STEMI, there was a significant difference in in-hospital mortality between Whites and non-Whites with highest risk in Hispanic/Latinx and Asian/Indigenous/Other. Further research in needed to explore discrepant outcomes in racial/ethnic minorities in this patient population and the role of discrepant management.
Abstract 14612: The Relationship Between Left Ventricular Geometry and Respiratory Sinus Arrhythmia in Patients With Vasovagal Syncope
Authors: Giorgia Coseriu, Csilla Andrea Eotvos, Iulia Zehan, Patricia C Tentea, Mihai G Andrei, Dan Blendea
Journal: Circulation (2022)

Introduction: The study was prompted by our observation that a significant number of patients with vasovagal syncope (VVS) have marked respiratory sinus arrhythmia as well as thin left ventricular (LV) walls. We hypothesized that the geometry of the LV walls may play a role in the pathogenesis of VVS. Hypothesis: The aim of this study was to assess LV geometry in relationship to respiratory sinus arrhythmia in patients with VVS M ethods: We included 191 patients (age 52±20 years, 101 women) with VVS who had either a positive or negative response to tilt table testing TTT (n=64 TTT+, and n=127 TTT-). The VVS group was compared to a group of 75 patients with no syncope (NL) and similar age, sex and BMI distributions. Standard 12-lead electrocardiograms (ECG), vectorcardiograms, and transthoracic echocardiograms were performed to assess electrical activation as well as ventricular geometry and function. The magnitude of respiratory sinus rhythm arrhythmia was measured as the maximum percent change in RR interval on a 10 second 12-lead ECG (dRR) performed before the TTT. Results: When compared to NL group patients with VVS had significantly higher dRR and LV end diastolic diameter (12 ±8% vs 10±8%, p=0.047 and 44±5 vs 46±6mm p=0.006 respectively) The end-diastolic thickness of the interventricular septum (IVS) and that of the LV posterior wall (PWT) in the VVS group were significantly smaller than in the NL group (8.9±1.7mm vs 9.6±1.8mm p value=0.003 and 8.4±1.5mm vs 9.2±1.6mm p value=0.0002). The magnitude of respiratory sinus arrhythmia expressed as dRR correlated inversely and significantly with IVS (r=-0.32; p value=0.042). The was however no significant correlation between dRR and PWT. These results suggest that a more pronounced respiratory sinus arrhythmia could be related to more ample variations in right and left ventricular filling due to increased ventricular interdependence via a thinner and more compliant ventricular septum. Conclusions: The geometry of the LV as well as the cardiovascular impact of respiratory movements may play a role in the pathogenesis of VVS.
Abstract 13087: Right Atrial Adaptation in Pulmonary Hypertension: Pressure-Volume and Histological Analysis
Authors: Jeroen N Wessels, Jessie Van Wezenbeek, Jari de Rover, rowan Smal, Aida Llucia-Valldeperas, Lucas Celant, J. Tim Marcus, lilian meiboom, Joanne Groeneveldt, Hans Niessen, Marie Jose J Goumans, Harm J Bogaard, Anton Vonk Noordegraaf, Gustav Strijkers, Berend Westerhof, Frances S De Man
Journal: Circulation (2022)

Introduction: Pulmonary arterial hypertension (PAH) is associated with increased right atrial (RA) pressure and volume. We hypothesized that these patients have RA hypertrophy, increased stroke work, fibrosis and stiffness and that RA adaptation falls short in severe right ventricular (RV) diastolic stiffness (end-diastolic elastance; E ed ). Methods: RA pressure-volume loops were created through a novel method in controls (N=9) and patients (N=27). RA volume was measured on a magnetic resonance transverse stack of slices and pressure with catheterization. In a larger cohort of controls (N=20) and PAH patients with low (N=39) or high E ed (N=41), RA volume was measured on a 4-chamber view and stroke work estimated through multiplying active emptying by A-wave pressure. Atriovenous stiffness was measured as the slope from minimal pressure and volume and V-wave. In PAH-patients (N=4) and controls (N=5) that died or underwent heart- and lung-transplantation, we collected RA tissue to study hypertrophy and capillarization (CD31 and wheat germ agglutinin staining) and fibrosis (Masson’s trichrome staining). Results: Averaged pressure-volume loops show RA dilatation in patients and elevated pressure, especially during atrial contraction. Atriovenous stiffness was similar in PAH and controls, but higher in high E ed when compared to low E ed patients. RA stroke work and pressure rise during atrial contraction were higher in PAH. However, when corrected for E ed , these parameters were decreased in high E ed patients, indicating RA-RV uncoupling. Histological analysis showed increased RA hypertrophy, number of capillaries per cardiomyocyte and perivascular/interstitial fibrosis in PAH patients. Conclusions: In PAH patients there is RA hypertrophy and increased stroke work. In severe RV diastolic stiffness, RA adaptation falls short and RA-RV uncoupling occurs. Although there is increased fibrosis, atriovenous stiffness is not different between PAH and controls.
Abstract 14546: Long-Term Outcome of Immediate Aortic Repair for Acute Type A Aortic Dissection Complicated With Brain Malperfusion
Authors: Takuro Tsukube, Chikashi Nakai, Reiko Kanno, Kazunori Sakaguchi, Mayo Kondo, So Izumi
Journal: Circulation (2022)

Introduction: Management of acute type A aortic dissection complicated by brain malperfusion remains controversial. We previously reported an excellent recovery of consciousness for patients with coma if aortic repair performed within 5 hours from onset of symptoms. This study evaluates neurological outcomes after 19 years with this approach. Methods: Between 8/03 and 12/21, aortic repair was performed in 400 patients with acute type A aortic dissection, including 59 (12.7%) presented with brain malperfusion on arrival. Brain malperfusion was defined as distributed consciousness or paralysis in patients with dissection in carotid artery on hospital arrival. Forty patients (67.8 %) were repaired within 5 hours from onset of symptoms (immediate repair) while 19 (32.2 %) were repaired after 5 hours (later repair). We compared the immediate repair group with the later repair group. The mean age of the patients was 70.0±11.7 and 70.0±9.0 years, respectively, and prevalence of shock, cardiac tamponade, EuroSCORE were not significantly different between two groups. Preoperative coma (GCS&lt;10) coexisted in 60.0 and 47.4%, respectively. For brain protection, deep hypothermia with antegrade cerebral perfusion was utilized. Glasgow Coma Scale (GCS) and modified Rankin Scale (mRS) were used for neurological evaluation. Results: Time from onset of symptoms to operating room was 3.4 ± 0.9 in immediate group and 14.2 ± 13.3 hours in later group. Total arch replacement was performed in 35.0 and 36.8%, respectively. Changes of GCS was significantly better in immediate group (p=0.03), and cut off value of time from onset to operating room for predicting consciousness recovery was 249minutes (p=0.02). Postoperative ADL independence (mRS&lt;3) was achieved in 50.0% (20/40) and 36.4% (7/19), respectively. The follow-up periods were between 0.6 and 216 (mean 47.8) months. Cumulative survival rate in 10 years of immediate group was 63.4% and significantly better than that of later group (49.0%). Conclusions: Long-term outcomes following the strategy of immediate aortic repair for acute type A aortic dissection complicated by brain malperfusion were satisfactory.
Abstract 14853: Epicardial Adipose Tissue Associates With High Cardiometabolic Risk and Fibro-Fatty Burden Longitudinally in Psoriasis
Authors: Ross OHagan, Christin Hong, Alexander Berg, Li-Yueh Hsu, Vy Bui, Haiou Li, Alvaro Gonzalez-Cantero, Marcus Y Chen, Heather L Teague, Alexander Sorokin, Nehal N Mehta
Journal: Circulation (2022)

Introduction: Psoriasis is a systemic inflammatory disease associated with increased cardiometabolic risk and coronary plaque burden. Epicardial adipose tissue volume (EATV) is considered a proinflammatory marker related to atherosclerotic plaque formation. The longitudinal impact of EATV on plaque characteristics, such as fibrofatty burden (FFB), assessed by coronary computed tomography angiography (CCTA), in psoriasis has not been reported. Hypothesis: 1) Psoriasis patients with increased EATV have a worse cardiometabolic profile and increased FFB. 2) Increasing EATV associates with increased FFB over four years. Methods: FFB by CCTA was assessed in three-hundred nineteen participants with psoriasis at baseline and one-hundred twenty-five at four years. A previously published automated framework for segmentation of the heart was used to generate EATV from non-contrast computed tomography scans and results were manually reviewed. Coronary characteristics were quantified using QAngio software. Results: Quartile analysis of EATV at baseline revealed a stepwise increase in hypertension (P&lt;0.001), waist to hip ratio (P&lt;0.001), visceral adiposity (P&lt;0.001), homeostatic model assessment for insulin resistance (P&lt;0.001), glycoprotein A (P&lt;0.001) psoriasis area severity index (P=0.005) and FFB (P&lt;0.001) with increasing EATV (Table 1). EATV associated with FFB (β=0.251; P &lt;0.001) in models adjusted for Framingham risk score and waist to hip ratio. Longitudinal analysis showed EATV associated with FFB over four years in models adjusted for Framingham risk score and waist to hip ratio in psoriasis (β=0.288; P =0.009). Conclusion: Our study supports that EATV correlates with a high cardiometabolic risk profile in psoriasis. Further, we show that as EATV increases, there is a heightened risk of rupture-prone fibrofatty plaque. Further studies are needed to elucidate the role of EATV in predicting cardiovascular disease risk associated with psoriasis.
Abstract 14663: The Impact of Continuous Positive Airway Pressure for Sleep Apnea on Left Atrial Dilatation in Patients Receiving Catheter Ablation of Atrial Fibrillation
Authors: Nobuaki Tanaka, Masato Okada, Koji Tanaka, Yuko Hirao, Shinichi Harada, Masatsugu Kawahira, Yasushi Koyama, Kenshi Fujii, Watanabe Heitaro, ATSUNORI OKAMURA, Katsuomi Iwakura
Journal: Circulation (2022)

Background Sleep apnea (SA) and left atrial dilatation (LA) are both risk factors for an arrhythmia recurrence after catheter ablation (CA) of atrial fibrillation (AF). Negative intrathoracic pressure fluctuations during an obstructive apnea episode may cause the left atrium to distend and stretch its wall. However, the impact of continuous positive airway pressure (CPAP) for SA on the reverse LA remodeling has not been elucidated. Methods This study was conducted under a retrospective, single-center, observational design. Data was derived from screening tests for sleep apnea, which were routinely performed in patients scheduled to receive CA of AF in our institution. The severity of the sleep apnea was evaluated by the apnea-hypopnea index (AHI). After excluding patients who were already diagnosed with sleep apnea, we enrolled 1232 consecutive patients who underwent multidetector computed tomography (MDCT) both before and 3-months after the CA of AF. The left atrial dilatation and volume reduction were evaluated by the left atrial minimum volume (LA min V) using 256-slice MDCT. Results The age was 65±11 years, 27.8% were females, and 46.0% had non-paroxysmal AF. The mean AHI was 20.2±15.2 and LA min V 79.1± 37.8ml (r=0.31, p&lt;0.0001) before CA. LA dilatation was defined as an LA min V≥79.1ml. After an adjustment by an advanced age (≥65 years), non-paroxysmal AF, male sex, obesity, hypertension, diabetes, and congestive heart failure, SA (AHI≥5) was a significant predictor of LA dilatation before CA (odds ratio 2.83, 95% confidence interval 1.55-5.16, p=0.0007). After CA, 206 out of 1092 patients (18.9%) with SA started CPAP. SA patients with CPAPs had a greater LA min V reduction rate on the postprocedural CT than those without CPAP (26.2% vs. 20.5%, p=0.013). Conclusion Among the patients scheduled to receive catheter ablation of AF, SA was independently associated with left atrial dilatation. Patients who started CPAP treatment for SA had greater LA reverse remodeling at 3 months after the CA.
Abstract 14632: Enhanced Therapeutic Effect on Myocardial Infarction by Using Thick and Viable iPSC Derived Cardiac Tissue
Authors: Junjun Li, Xiang Qu, lingjun Li, YING HUA, jingbo zhang, Takuji Kawamura, Ryohei Matsuura, Nagako Sougawa, Emiko Ito, Noriko Mochizuki-oda, Akima Harada, Yoshiki Sawa, Li LIU, Shigeru Miyagawa
Journal: Circulation (2022)

Introduction: Human iPSC derived cardiomyocytes (iPSC-CMs) have been proved to be a promising method to treat the heart failure. Multiple clinical studies including one in our group are ongoing around the world. Due to the diffusion limit, so far it is difficult to prepare viable cardiac tissue with high thickness. We hypothesized that by using multilayer fiber sheets and enhanced perfusion system, viable and thick cardiac tissue could be obtained for improved therapeutic effect for treating myocardial infarction. Method and Results: PLGA fiber sheet with multilayer and high porosity (30.61% ± 1.85%, n = 4) was fabricated for iPSC-CMs penetration and organization. A low-shear stress perfusion system was developed to promote the oxygen diffusion in the thick tissue. At day 5, multilayer cardiac tissue showed compact structure with thickness of 878.64 ± 193.45 μm (n = 4) and viability of 85.32 % ± 6.75 % (n = 4). Compared with the single layer tissues, the multilayer cardiac tissues demonstrated improved contractile properties and secretion of angiogenesis factors: VEGF, HGF and TGF-β1. When used for treating rat with myocardial infarction, multilayer group showed significantly improved left ventricular ejection fraction (0 vs. 4 week: 39.1 ± 4.6 % vs. 52.3 ± 7.8 %, n=8, p = 0.0029), whereas the control group showed no significant change (0 vs. 4 week: 40.6 ± 5.4 % vs. 44.9 ± 4.1 %, n=8, p = 0.37). The staining on sliced heart confirmed the survival of transplanted cells in large area. Moreover, the multilayer group showed significantly lower fibrosis at the border zone than the control group (10.8 % ± 3.1 % vs. 16.4 % ± 5.9 %, n=7, p=0.024). There are no significant differences in cell diameter and capillary density in border zone between two groups. Both groups showed no significant inflammatory reactions (CD68). Conclusion: By using multilayers fiber sheet and enhanced perfusion system, viable and thick iPSC-cardiac tissue could be obtained with enhanced features over the single layer cardiac tissue such as contractility and secretion. While used for transplantation, the multilayers cardiac tissue demonstrated improved therapeutic effect for treating myocardial infarction, holding high potential for future clinical applications.